Effectiveness of cefmetazole versus meropenem for invasive urinary tract infections caused by extended-spectrum β-lactamase-producing Escherichia coli

Hayakawa, Kayoko; Matsumura, Yasufumi; Uemura, Kohei; Tsuzuki, Shinya; Sakurai, Aki; Tanizaki, Ryutaro; Shinohara, Koh; Hashimoto, Takehiro; Hase, Ryota; Matono, Takashi; Kato, Hideaki; Mawatari, Momoko; Hara, Hiroshi; Hamada, Yukihiro; Saito, Sho; Ohmagari, Norio; Doi, Yohei

doi:10.1128/AAC.00510-23

Title

Effectiveness of cefmetazole versus meropenem for invasive urinary tract infections caused by extended-spectrum β-lactamase-producing Escherichia coli

Author

Hayakawa, Kayoko

Matsumura, Yasufumi

Uemura, Kohei

Tsuzuki, Shinya

Sakurai, Aki

Tanizaki, Ryutaro

Shinohara, Koh

Hashimoto, Takehiro

Hase, Ryota

Matono, Takashi

Kato, Hideaki

Mawatari, Momoko

Hara, Hiroshi

Hamada, Yukihiro

Saito, Sho

Ohmagari, Norio

Doi, Yohei

Abstract

Cefmetazole is active against extended-spectrum beta-lactamase-producing Escherichia coli (ESBLEC) and is a potential candidate for carbapenem-sparing therapy. This multicenter, observational study included patients hospitalized for invasive urinary tract infection due to ESBLEC between March 2020 and November 2021 at 10 facilities in Japan, for whom either cefmetazole or meropenem was initiated as a definitive therapy within 96 h of culture collection and continued for at least 3 d. Outcomes included clinical and microbiological effectiveness, recurrence within 28 d, and all-cause mortality (14 d, 30 d, in-hospital). Outcomes were adjusted for the inverse probability of propensity scores for receiving cefmetazole or meropenem. Eighty-one and forty-six patients were included in the cefmetazole and meropenem groups, respectively. Bacteremia accounted for 43% of the cefmetazole group, and 59% of the meropenem group. The crude clinical effectiveness, 14 d, 30 d, and in-hospital mortality for patients in the cefmetazole and meropenem groups were 96.1% vs 90.9%, 0% vs 2.3%, 0% vs 12.5%, and 2.6% vs 13.3%, respectively. After propensity score adjustment, clinical effectiveness, the risk of in-hospital mortality, and the risk of recurrence were similar between the two groups (P = 0.54, P = 0.10, and P = 0.79, respectively). In all cases with available data (cefmetazole : n = 61, meropenem : n = 22), both drugs were microbiologically effective. In all isolates, bla(CTX-M) was detected as the extended-spectrum beta-lactamase gene. The predominant CTX-M subtype was CTX-M-27 (47.6%). Cefmetazole showed clinical and bacteriological effectiveness comparable to meropenem against invasive urinary tract infection due to ESBLECs.

Language

English

Source (journal)

Antimicrobial agents and chemotherapy. - Washington, D.C., 1972, currens

Publication

Washington, D.C. : American Society for Microbiology , 2023

ISSN

0066-4804

DOI

10.1128/AAC.00510-23

Volume/pages

67 :10 (2023) , p. 1-13